抗抑郁药及性激素治疗围绝经期及绝经后妇女抑郁症的疗效比较  

Comparison of antidepressive drugs and hormone replacement therapy in perimenopausal andpostmenopausal women with depression

作　　者：彭保安[1] 张武文[1] 张润驹[1] 唐文[2] 程卫国[2] 

机构地区：[1]浙江大学医学院附属妇产科医院妇科,杭州310006 [2]杭州市第七人民医院

出　　处：《中华精神科杂志》2012年第3期141-144,共4页Chinese Journal of Psychiatry

摘　　要：目的比较抗抑郁药及性激素治疗围绝经期及绝经后妇女抑郁症的临床疗效。方法将120例围绝经期及绝经后抑郁症女性按人组顺序分为A、B、C3组（每组40例），采用24项汉密尔顿抑郁量表（HAMD24）对其进行抑郁程度评价，然后根据HAMD评分每组再分为轻中度组及重度组2个亚组。A组应用抗抑郁药盐酸氟西汀（20mg／d）＋性激素替勃龙（1．25mg／d）治疗，B组应用盐酸氟西汀（20mg／d）治疗，C组应用替勃龙（1．25mg／d）治疗；连续服药2个月后进行HAMD24评定，同时计算治疗总有效率。结果（1）临床疗效比较：A、B、C3组的轻中度亚组治疗总有效率分别为96％、95％、93％，差异无统计学意义（P〉0．05）；重度亚组治疗总有效率分别为93％、83％、46％，A、B2组的重度亚组治疗总有效率明显高于C组（P〈0．05），且A组的重度亚组治疗总有效率高于B组（P〈0．05）。（2）治疗前后HAMD24评分比较：治疗后3组的轻中度亚组HAMD24评分比较差异无统计学意义（P〉0．05），但治疗后HAMD24评分均明显低于治疗前基线水平[治疗前分别为（29．0±4．8）、（27．4±5．3）、（27．94±4．2）分，治疗后分别为（3．9±3．2）、（4．2．4±3．6）、（4．4±3．0）分；P〈0．05]；治疗后，A、B2组重度亚组的HAMD24评分明显低于C组[治疗前分别为（38．24±5．4）、（37．8±4．9）、（37．3±5．3）分，治疗后分别为（5．74±2．5）、（8．4±2．8）、（20．8±5．2）分；P〈0．05]，且A组重度亚组的HAMD24评分低于B组（P〈0．05）。结论围绝经期及绝经后合并轻中度抑郁症妇女抗抑郁药治疗及激素替代治疗效果相当，重度抑郁症女性则两药联用效果更佳。Objective To study the effects of antidepressive drugs and hormone replacement therapy （HRT） in perimenopausal and postmenopausal women with depression. Methods All 120 perimenopausal and postmenopausal women with depression were divided into 3 groups. Among them, mildmoderate depression and severe depression were divided according to their Hamilton Depression Rating Scale for Depression （HAMD24） score of ≤35 and treated for 2 months, respectively. All patients were assessed with the HAMD24 before and after treatment. The first group received fluoxetine （20 mg/d） and tibolone （ 1.25 mg/d）, the second group took fluoxetine （20 mg/d）, and the third group took tibolone （ 1.25 mg/d）. Results （ 1 ） The effective rate of the three groups was 96% , 95 % , 93% , respectively, in mild-moderate depression before and after treatment （ P 〉 0. 05 ） , while the efficacy was significantly different between the three groups in severe depression before and after treatment （ P 〈 0. 05 ）, with higher response rates in the first severe sub-group （93%） and the second severe sub-group （83%） than the third severe sub-group （46%） （P 〈0. 05）. （2） There were no significant differences （P 〉0. 05） on the HAMD24 before and after treatment in mild-moderate depression between three groups [ HAMD24 scores before treatment were （ 29. 0 ± 4. 8）, （27.4± 5.3）, （27.9 ± 4. 2 ）, respectively, and after treatment were （ 3.9 ± 3.2）, （4. 2± 3.6）, （4. 4 ± 3.0 ） , respectively ] . There were significant differences （ P 〈 0. 05 ） on HAMD24 scores after treatment between the first severe sub-group and the third severe sub-group, the second severe sub-group and

关 键 词：抑郁症 围绝经期 氟西汀 激素替代疗法 替勃龙 

分 类 号：R711.75[医药卫生—妇产科学]